scholarly journals 358 Clinical characteristic and natural history of chemotherapy induced dilated cardiomyopathy

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Andrea Lalario ◽  
Eva Del Mestre ◽  
Michele Lo Casto ◽  
Vincenzo Nuzzi ◽  
Antonio Cannatà
Keyword(s):  
Dilated Cardiomyopathy ◽  
Cardiac Death ◽  
Primary Outcome ◽  
Multivariable Analysis ◽  
Secondary Outcome ◽  
Ventricular Assist ◽  
Device Implantation ◽  
Kaplan Meier ◽  
History Of ◽  
Clinical Characteristic

Abstract Chemotherapy can lead to chemotherapy-induced dilated cardiomyopathy (CI-DCM), recognized as one of the Non-ischaemic Dilated Cardiomyopathy (DCM) phenotypes characterized by worse outcome. Evidences on a direct comparison between idiopathic-DCM (iDCM) and CI-DCM still lack. We included all the consecutive patients enrolled in the Trieste Muscle Heart Disease Registry. C-DCM was defined according to current recommendations. Uni- and multivariable analysis and Kaplan-Meier were performed. The primary outcome was all-cause death and the secondary outcomes were cardiac death and a composite of heart failure hospitalization, heart transplantation, ventricular assist-device implantation and major ventricular arrhythmias. The study included 511 patients (499 patients affected by iDCM and 52 patients affected by CI-DCM). Compared to iDCM, CI-DCM patients were older (51 ± 14 years vs. 58 ± 3 years respectively, P < 0.001) and had a higher LVEF (35%±10 vs. 32%±9, P = 0.03). CI-DCM patients had a higher incidence of all-cause of death compared to iDCM (36.5% vs. 8.4%, P < 0.001), while the incidence of cardiac death (7% in the CI-DCM group vs. 4% in the iDCM group, P = 0. 232) and of the composite secondary outcome was comparable amongst the two groups. At multivariable analysis, the diagnosis of CI-DCM was an independent predictor of primary outcome incidence (HR: 5.79, 95% CI: 1.83–18.27), P = 0.003, together atrial fibrillation. In a well-selected DCM cohort, patients with a chemotherapic etiology had a higher incidence of all-cause mortality compared to iDCM, while the incidence of cardiac adverse events was comparable among CI-DCM and iDCM.

Abstract 17492: Extent and Pattern of Late Gadolinium Enhancement Predict Arrhythmic Events in Patients With Nonischemic Dilated Cardiomyopathy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Dong Geum Shin ◽  
Hye-Jeong Lee ◽  
Junbeom Park ◽  
Young Jin Kim ◽  
Jae-Sun Uhm ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Ventricular Arrhythmia ◽  
Dilated Cardiomyopathy ◽  
Cardiac Death ◽  
Primary Outcome ◽  
Multivariable Analysis ◽  
Gadolinium Enhancement ◽  
Nonischemic Dilated Cardiomyopathy ◽  
The Impact

Background: Late gadolinium enhancement (LGE) by cardiac MR (CMR) has been related to adverse clinical outcomes in patients with nonischemic dilated cardiomyopathy (NIDC). But, a statistically significant association between LGE and arrhythmic risk in NIDC has not been demonstrated consistently. This study evaluated the impact of the presence, location and pattern of LGE on arrhythmic risk prediction in NICM. Methods: This study included 365 patients (54±15years) with NICM who underwent CMR. The extent, location and pattern of LGE were categorized. We analyzed for the primary outcome of ventricular arrhythmia (VA) including sustained or nonsustained ventricular tachycardia (VT), appropriate implantable cardioverter-defibrillator (ICD) intervention and ventricular fibrillation (VF). Cardiac death and hospitalization for heart failure (HF) were evaluated as secondary outcomes. Results: LGE was seen in 267 (73 %) patients. During median follow-up of 44±36 months, patients with LGE had higher incidence of cardiac death (15 % vs. 2 %, p<0.001), hospitalization for HF (40 % vs. 15 %, p<0.001) and VA (14% vs. 6%, p=0.03). In multivariable analysis, the presence of LGE (HR 2.78; 95% CI 1.10-7.02; p=0.03) was the independent predictor of arrhythmias. Patients with extensive LGE had higher VA (32% vs. 10%, p<0.001) with lower cumulative survival free of VA than those without extensive LGE (p=0.001). The frequent LGE location was as follows: LV septum 64%, LV-RV junction 42% and inferior 10%. VA was lower in patients with than without localized LGE limited to LV-RV junction (21% vs. 46%, p=0.005). Interestingly, while the incidence of ventricular arrhythmia was higher in patients with transmural LGE (29% vs. 10%, p=0.003), it was lower in those with patch LGE (2% vs. 16%, p=0.02) than the other patients. Conclusions: In patients with NICM, the LGE was an independent prognostic predictor of VA. Extensive LGE and specific location of LGE was related with the arrhythmic events.

Abstract 17191: Fragmentation Assessed by Magnetocardiography but not Electrocardiogram Can Predict Future Cardiac Events in Patients with Non-ischemic Dilated Cardiomyopathy and Narrow QRS

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Shoji Kawakami ◽  
Hiroshi Takaki ◽  
Shuji Hashimoto ◽  
Mitsuru Wada ◽  
Kohei Ishibashi ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Laboratory Data ◽  
Left Ventricular ◽  
Cardiac Events ◽  
Ventricular Assist ◽  
Device Implantation ◽  
Narrow Qrs ◽  
Kaplan Meier ◽  
Non Ischemic Dilated Cardiomyopathy ◽  
Spatio Temporal

Background: Fragmented QRS (fQRS) in 12-lead ECG, ascribed to myocardial scar, has been shown to predict future cardiac events in patients with both ischemic and non-ischemic dilated cardiomyopathy (NIDCM). Various definitions and low specificity of fQRS, however, limited its use. We hypothesized that the advantage of 64-channel magnetocardiography (MCG), i.e., high spatio-temporal resolution, enables more accurate detection of fragmented LV conduction (fLV), that would lead to accurate prediction of future events. Methods: In 51 patients with NIDCM and narrow QRS (LVEF, 22±7%; QRS duration, 99±11 ms), we recorded MCG. We defined, in MCG superimposed vector magnitude waveforms, fLV as distinct abnormal components (>20% of maximal amplitude). In current arrow map, fLV corresponded to heterogeneous QRS currents (Figure). We predicted major adverse cardiac events (MACE), including sudden cardiac death (SCD), sustained ventricular tachyarrhythmias (VF/VT), appropriate defibrillator discharge (Def) and left ventricular assist device implantation (LVAD). Results: fLV was present in 27 (Group-F) and not in 24 (Group-N). Age, gender, ECG and echocardiographic findings, laboratory data and medications were similar irrespective of fLV. During a mean follow-up of 2.2 years, MACE occurred in 19 (4 SCD, 9 VF/VT, 2 Def, and 4 LVAD). MACE more frequently occurred with fLV (63%, 17/27) than without (8%, 2/24, Kaplan-Meier analysis, p<0.001). Multivariate analysis revealed fLV as the only independent predictor of MACE (HR 4.82, p=0.015). Conclusion: MCG analysis is a promising noninvasive tool to accurately detect fragmentation and predict MACE in patients with NIDCM and normal QRS.

scholarly journals GP.04 Prevalence and determinants of seizure action plans in a pediatric epilepsy population

2019 ◽  
Vol 46 (s1) ◽  
pp. S7
Author(s):  
M Chiu ◽  
S Peinhof ◽  
M Borhani ◽  
C DeGuzman ◽  
C Siu ◽  
...  
Keyword(s):  
Mobile Application ◽  
Chart Review ◽  
Primary Outcome ◽  
Action Plan ◽  
Univariate Analysis ◽  
Male Gender ◽  
Secondary Outcome ◽  
Pediatric Epilepsy ◽  
History Of ◽  
Timely Treatment

Background: Status epilepticus (SE) is the most common pediatric neurological emergency. Timely treatment is crucial, yet administration of rescue medications is often delayed and under-dosed. We aim to improve SE management by ensuring that every child at risk of SE in our province has an individualized seizure action plan (SAP) outlining the steps that should be taken during SE. Methods: A survey was distributed to parents of epilepsy patients aged 1 month to 19 years. Primary outcome was percentage of patients with SAPs. Secondary outcome was parental interest in a SAP mobile application. Following chart review, univariate and multivariate analysis was performed to identify variables that predict whether patients have SAPs. Results: Of 192 participants, 61.5% have SAPs. On univariate analysis, history of prior SE and male gender increased likelihood of having a SAP. On logistic regression, Nagelkerke R2 was 0.204 and our model correctly predicted 82.2% of patients with SAPs. 83.3% of parents were interested in a SAP mobile application. Conclusions: This is one of the first studies to examine SAP prevalence in a pediatric epilepsy population. There is a need to increase the percentage of epilepsy patients with SAPs. Most parents would find a SAP mobile application valuable in their child’s management.

scholarly journals Ischemic Etiology and Clinical Outcomes Following Cardiac Resynchronization Therapy

Medicina ◽  
2020 ◽  
Vol 56 (3) ◽  
pp. 110
Author(s):  
Teruhiko Imamura
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Cardiac Death ◽  
Cardiac Resynchronization ◽  
Prognostic Impact ◽  
Resynchronization Therapy ◽  
Assist Device ◽  
Ventricular Assist ◽  
Device Implantation ◽  
Selection For ◽  
Ischemic Coronary Disease

Optimal patient selection for cardiac resynchronization therapy is crucial. There are several concerns that allow to better clarify the association between the ischemic etiology of heart failure and the response to cardiac resynchronization therapy. The type of ischemic coronary disease has an impact on the responses to cardiac resynchronization therapy. The prognostic impact of cardiac resynchronization therapy on cardiac death including heart transplantation and durable ventricular assist device implantation is another concern.

scholarly journals Clinical Impact of the Revised 2019 CLSI Levofloxacin Breakpoints in Patients with Enterobacterales Bacteremia

2021 ◽  
Author(s):  
Ho-Yin Huang ◽  
Chu-Feng Wang ◽  
Po-Liang Lu ◽  
Sung-Pin Tseng ◽  
Ya-Ling Wang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Clinical Evidence ◽  
Inhibitory Concentration ◽  
Clinical Impact ◽  
Secondary Outcome ◽  
Lower Survival Rate ◽  
Multivariable Logistic Regression ◽  
Kaplan Meier

Background The Clinical and Laboratory Standards Institute (CLSI) revised the fluoroquinolone minimal inhibitory concentration (MIC) breakpoints for Enterobacterales in 2019, based on pharmacokinetic/pharmacodynamic analyses. However, clinical evidence supporting these breakpoints revision is limited. Methods A retrospective cohort was conducted at 3 hospitals in Taiwan between January 2017 and March 2019. Patients treated with levofloxacin for Enterobacterales bacteremia with high-MIC (1 or 2 μg/mL; levofloxacin-susceptible by pre-2019 CLSI breakpoints) were compared with those with low-MIC (≤0.5 μg/mL; levofloxacin-susceptible by 2019 CLSI breakpoints) to assess therapeutic effectiveness in multivariable logistic regression. The primary outcome was 30-day mortality and the secondary outcome was the emergence of levofloxacin-resistant isolates within 90 days after levofloxacin initiation. Results A total of 308 patients were eligible in the study. Kaplan-Meier analysis showed that patients infected with high-MIC isolates (n=63) had a significantly lower survival rate compared with those infected with low-MIC isolates (n=245) (p=0.001). Multivariable logistic regression revealed high levofloxacin MIC was a predictor of 30-day mortality [odds ratio (OR) 6.05, 95% confidence interval (CI) 1.51-24.18, p=0.011]. We consistently found similar result in propensity-score matched cohort (OR 5.38, 95%CI 1.06-27.39, p=0.043). The emergence of levofloxacin-resistant isolates was likely more common in the high-MIC group compared to the low-MIC group (7.5% vs. 25.0%, p=0.065). An estimated AUC/MIC ratio≥ 87 was significantly associated with better survival (p=0.002). Conclusions Patients with high levofloxacin MICs within the pre-2019 CLSI susceptible range of 1 or 2 μg/mL were associated with higher mortality compared to those with MICs ≤0.5 μg/mL.

scholarly journals Children Listening to Music or Watching Cartoons During ER Procedures: A RCT

2019 ◽  
Vol 44 (10) ◽  
pp. 1151-1162
Author(s):  
Marianne J E van der Heijden ◽  
Hiske Mevius ◽  
Nicky van der Heijde ◽  
Joost van Rosmalen ◽  
Sebastian van As ◽  
...  
Keyword(s):  
Heart Rate ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Multivariable Analysis ◽  
Pain Scale ◽  
Secondary Outcome ◽  
Control Groups ◽  
Video Footage ◽  
Alder Hey ◽  
And Control

Abstract Objective This study aims to determine if listening to music and watching cartoons are effective to distract children from pain and distress during procedures in the emergency room (ER). Methods This study is a single-center, 3-armed, superiority randomized controlled trial comparing listening to music, watching cartoons, and standard care during ER procedures in children aged 3–13 years. The primary outcome was pain measured from video footage with the Alder Hey Triage Pain Score (AHTPS). Children older than 4 years self-reported pain with the Faces Pain Scale-Revised (FPS-R). The secondary outcome was distress measured with the Observational Scale of Behavioral Distress-revised (OSBD-r). Another indicator of distress was heart rate. Results Data of 191 participants were analyzed for the 3 groups: music (n = 75), cartoon (n = 62), and control (n = 54). The median age was 7.3 years (4.9–9.7). In multivariable analysis, pain assessed with the AHTPS was significantly lower (B = −1.173, 95% confidence interval −1.953, −0.394, p = .003) in the music group than in the control groups. Across the 3 groups, 108 children self-reported pain with the FPS-R after the procedure. The scores were lowest in the music group, but the differences between groups were not significant (p = .077). OSBD-r distress scores assigned during the procedures were not significantly different between the 3 groups (p = .55). Heart rate directly after the procedure was not statistically significantly different between the 3 groups (p = .83). Conclusions Listening to recorded music is a beneficial distraction for children experiencing pain during ER procedures, whereas watching cartoons did not seem to reduce pain or distress.

Abstract 2889: Prediction of Cardiac Stability after Weaning from Left Ventricular Assist Devices in Patients with Idiopathic Dilated Cardiomyopathy

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Michael Dandel ◽  
Yuguo Weng ◽  
Henryk Siniawski ◽  
Evgenij Potapov ◽  
Thorsten Drews ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Predictive Value ◽  
Time Course ◽  
Wall Motion ◽  
Ventricular Assist Devices ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Motion Velocity ◽  
Ventricular Assist ◽  
Off Pump ◽  
History Of

Background: The use of ventricular assist devices (VADs) as bridge to transplantation (Tx) has become a standard therapeutic option in end-stage heart failure (HF). During unloading clinical recovery which allows reliable weaning from VADs is possible. After 12 years of weaning experience, we searched for parameters that are predictive for post-weaning cardiac stability and thus helpful for future weaning decisions. Methods: With regard to potential prediction of weaning success we evaluated echocardiographic parameters obtained during final ``off pump” trials before VAD explantation, histological changes and serum anti-ß1-adrenoreceptor autoantibody disappearance during unloading, duration of mechanical support and duration of HF. Among 79 patients weaned since 3/1995, a homogenous group of 35 patients with idiopathic dilated cardiomyopathy (IDCM) weaned from LVADs were selected for evaluation. Results: The 8-year post-weaning survival reached 78.1 ±8.2%. Freedom from HF recurrence at 4 years after weaning was 69.3 ±8.1%. Patients with post-weaning cardiac stability were younger, history of HF and recovery time during unloading shorter, LV short/long axis ratio lower (less spherical) and systolic wall motion velocity (measured by tissue Doppler) higher (p< 0.05). For LVEF ≥ 45% at LV enddiastolic diameter (LVEDD) ≤ 55mm the positive predictive value for ≥ 4 years cardiac stability reached 90.5%. There was no HF recurrence during the first 4 years in patients with LVEF ≥ 45%, LVEDD ≤ 55% and history of HF < 5 years. The time course of LVEF during the first 6 months also appeared predictive for long-term stability after weaning. History of HF > 5 years showed a predictive value of 90% for HF recurrence during the first 3 years. Neither reduction in myocardial hypertrophy and fibrosis nor serum anti-ß1-adrenoreceptor autoantibody disappearance during unloading appeared predictive for post-weaning stability. Conclusions: Off-pump LVEF and LVEDD, time course of LVEF during the first 6 months after weaning and duration of HF are predictive for the outcome after LVAD removal in IDCM patients. Patients’ age, altered LV geometry, low wall motion velocity and prolonged LVAD support until improvement (> 6 months) appeared to be risk factors for HF recurrence.

Left ventricular assist device implantation in patients with a history of malignancy

2020 ◽  
Vol 35 (9) ◽  
pp. 2224-2231 ◽  
Author(s):  
Yeahwa Hong ◽  
Laura Seese ◽  
Gavin Hickey ◽  
Shangzhen Chen ◽  
Michael A. Mathier ◽  
...  
Keyword(s):  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Assist Device ◽  
Ventricular Assist ◽  
Device Implantation ◽  
Left Ventricular Assist ◽  
History Of
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